Pre-Menstrual Syndrome and Dysmenorrhea Ayurveda Treatment

Pre-Menstrual Syndrome and Dysmenorrhea

 

Pre-Menstrual Syndrome or PMS is correlated with ‘Aartava Dushti’ (menstrual disorders). Aartava means menstruation and Dushti means disorders.

 

 

Causes of Aartava Dushti

Indulgence in causative factors disturbs the equilibrium and proper functioning of Vata and other Doshas thereby leading to PMS.  The various causative factors of PMS are explained below.

Aharaja Nidana: Dietetic Factors

Untimely meals, excess coffee and tea and increased intake of dry food items, cold food and drinks increase the Doshas in the body, especially Vata and Pitta leading to Pre-Menstrual Syndrome.

Viharaja Nidana: Lifestyle Factors

Hectic work or excess physical activity especially during menstrual period and suppression of natural urges like urge to open bowels or urinate, urge to pass wind or burp etc , mental stress, excessive sexual intercourse leads to increase of Vata Dosha. This in turn causes profuse menstrual bleeding or variation in menstrual cycles.

Day sleep, Excess sleep and Sedentary Lifestyle leads to increase in Kapha Dosha which in turn obstructs the menstrual flow causing clot formation or scanty menses and slimy menstrual discharge.

Nutritional Deficiencies

In present day busy lifestyle, we often skip breakfast or have ready to eat food for breakfast which lacks the essential nutrients. Also, insufficient intake of dietary proteins and iron also leads to compromised nutrition.

Pathogenesis

Indulgence in causative factors leads to vitiation of the three Doshas causing PMS. Ayurveda theory points to the buildup of Ama (metabolic toxins and impurities) and blockage of Aratava vaha srotas (Channels of menstruation) as a major contributing factor in PMS symptoms. When Ama accumulates in the female reproductive system, it leads to obstruction in the regular movement of Vata Dosha causing menstrual disturbances. Low digestive fire and unhealthy diet leads to Ama formation. Present day lifestyle is stressful which also aggravates the symptoms. Poor eating habits, sedentary lifestyle, improper sleeping pattern affects the biological rhythm of the body disturbing the normal physiology of menstruation.

As different women experience different symptoms during PMS, understanding the type of symptoms will help to understand the underlying Dosha vitiated thereby helping decide suitable treatment accordingly.

Pathogenic Factors

Doshas	All three Doshas with predominance of Vata Dosha Subtype of Vata involved - Vyana & Apana Vata Subtype of Pitta involved – Ranjaka, Pachaka Subtype of Kapha involved – Kledaka Kapha
Dhatu	Rasa (Lymph), Rakta (Blood) and Artava (Reproductive tissue)
Status of Agni	Low Jataragni & Dhatvagni (Digestive & Metabolic fire)
Srotas (Channels of circulation) involved	Rasavaha Srotas (Channels carrying lymph) Raktavaha Srotas (Channels carrying blood) Artavavaha Srotas (Channels carrying menstrual fluid)
Srotodushti (Type of vitiation of channels of circulation)	Sanga (Obstruction) and Vimargagamana (Reverse flow)
Udbhavasthana (Site of origin of disease)	Amashaya – Pakwashaya (Stomach & Large intestine)
Rogamarga (Pathway of disease)	Abhyantara (Internal pathway)
Vyakta Sthana (Site of manifestation of disease)	Garbhashaya (Uterus)

 

Symptoms of Aartava Dushti

The symptoms of PMS can include depression, irritability, mood swings, food cravings, weight gain, bloating, cramping, and acne. PMS symptoms vary according to whether the underlying imbalance is in Vata, Pitta or Kapha. The symptoms usually occur one to two weeks before menstrual period.

• Typical symptoms of a Vata imbalance during the premenstrual period are anxiety, nervous tension, mood swings, dysmenorrhea (pain or cramps during menses), irregularity of menses and feeling "spaced out."
• For Pitta, however, the mood is more anger and irritation; there is also occurrence of acne, excess body heat, headache and menorrhagia (excessive menstrual bleeding).
• Kapha, as always is typified by lethargy. Other symptoms of Kapha imbalance include weight gain, laziness tendency, fluid retention, pale and mucous like menstrual flow and depression. 

Classification of Aartava Dushti

These are eight in numbers based on causative Dosha. (Ref Sloka 1)

Vataja Aartava Dushti

Causative Dosha – Vata

Symptoms - Menstrual blood is red, black or dark brown in colour and is thin, scanty, frothy or with small clots. The menstrual blood is excreted slowly and with pain, especially piercing type of pain is experienced. The quantity of menstrual blood discharged is less. Associated symptoms such as general weakness, fatigue and discomfort can be noticed. 

Pittaja Aartava Dushti

Causative factor	Pitta
Symptoms	Menstrual blood is hot and has a putrid smell. It is not very unctuous. There is feeling of heat and burning sensation at the time of excretion of menstrual blood.

Kaphaja Aartava Dushti

Causative factor	Kapha
Symptoms	Menstrual blood is slimy and pale in colour, very thick, slippery and unctuous.

Kunapagandhi Aartava Dushti

Kunapa means putrid or rotten and Gandhi means smell, thus Kunapagandhi means putrid or rotten smell.

Causative factor	Rakta (Blood tissue)
Symptoms	The amount of blood discharged during menstruation is abundant and is bright red like fresh blood. Associated symptoms include heat and burning sensation like the Pittaja Aartava Dushti.

Granthibhuta Aartava Dushti

Granthibhuta means clot like appearance.

Causative factor	Vata and Kapha
Symptoms	Menstrual blood appears clotted, that is like a thick mucoid or mucopurulent discharge associated with slough. Other associated symptoms include painful menses and unctuousness or sliminess of the menstrual fluid because of vitiation of Vata and Kapha Doshas.

This type is mostly seen in malignant disorders of the reproductive organs, especially cervix.

Puti Puyanibha Aartava Dushti / Puyanibha Aartava Dushti

Puti means Putrid and Puyanibha means Purulent. Thus, Puti Puyanibha Aartava Dushti means Putrid and Purulent discharge of blood.

Causative factor	Pitta and Kapha Dosha
Symptoms	Menstrual flow is associated with burning sensation, increase of body heat, feverish feeling and heaviness in the body, especially abdomen. Menstrual blood resembles pus, that is it is slimy and having putrid smell.

This condition occurs mostly in acute infective condition of the reproductive system.

Kshina Aartava Dushti

Kshina means Scanty.

Causative factor	Pitta and Vata Dosha
Symptoms	Menstrual cycle is delayed and there is scanty flow of menses associated with pain in the vagina and burning sensation.

This occurs mainly due to mild hypo functioning of ovary caused by deficiencies.

Mutrapurishagandhi Aartava Dushti

Mutra means urine, Purisha means faecal matter and Gandhi means smell, thus Mutra Purisha Gandhi means smell of urine and faecal matter.

Causative factor	All three Doshas
Symptoms	It will have mixed features of all three Doshas.

Ayurveda treatments are individualized based upon a person’s Dosha imbalance. Specific symptoms of PMS, their related imbalances and possible treatments are explained below.

Aartava Dushti and Dysmenorrhea

More than half of all girls and women suffer from dysmenorrhea (cramps during menstruation) all over the world. Irregular menstrual cycles and variation in bleeding pattern has become a challenging problem for women of all age groups including young girls, working class woman as well as housewives because of the changing modern-day diet and lifestyle.

Causative Factors

·      Avyayama: Lack of physical activity

·      Ajirna: Indigestion

·      Katu Lavana Ahara: Excess intake of spicy and salty food

·      Lack of personal hygiene

Pathogenesis

According to Ayurveda, due to indulgence in causative factors, the aggravated Apana Vata (A type of Vata Dosha) obstructed in its normal downward flow, moves in upward direction and afflicts the uterus. Hence there is pain in uterus and menstrual blood is retained in the uterus and is pushed upwards because of vitiated Apana Vata leading to painful and irregular contractions causing discharge of menstrual blood with spasmodic pain and difficulty. The woman feels comfort immediately after discharge of menstrual blood.

 

Symptoms

Ayurveda describes the condition of Udavartini Yoni Vyapad that resembles dysmenorrhea (Ref Sloka 2). Dysmenorrhea is explained as a symptom and its Ayurvedic term is Kashtartava. Dull but throbbing pain occurs in lower abdominal region and radiates to the low back or thighs during menstrual period. It is associated with other PMS symptoms like Nausea, Vomiting, Diarrhea or constipation, Headache, Dizziness, Fainting and fatigue.

The likelihood that a woman will have cramps increases if she leads a stressful life, lack of exercise, uses alcohol, caffeine in excess and if she has endometriosis, uterine fibroids or pelvic inflammatory disease.

Ayurveda Approach to Dysmenorrhea

·      Sthanika Abhyanga (Local Massage) with lukewarm Dashmool oil on the lower abdomen, low back region and hips followed by Swedana (Hot compress) helps relieve pain during menses as it helps to remove blockage and regulate Vata Dosha (Ref Sloka 3).

·      Panchakarma therapies especially Uttarabasti (Intraurethral enema), Anuvasana Basti (Unctuous enema) helps in correcting derangement of Vata Dosha specifically in menstrual problems.

·      Herbs that strengthen the uterus such as Dashmool (Root of 10 herbs), Shatavari (Asparagus racemosus), Ashoka (Saraca asoca), Rasna (Pluchea lanceolata), Bala (Sida cordifolia), Devadaru (Cedrus deodara), Musta (Cyperus rotundus), Ushira (Vetiveria zizanioides), Punarnava (Boerhavia diffusa), Darbha (Desmostachya bipinnata) are beneficial.

·      Ayurveda herbal preparations such as Sukumara Kashaya, Ashokarishta, Kumaryasava, Chandraprabha vati are beneficial.

 

·      Some other useful Ayurveda recipes –

                        i.         Milk decoction of Dashmool

                       ii.         Administer Cassava (Manihot esculenta) with water.

                      iii.         Shatavari powder is administered with cane sugar and caraway.

                      iv.         Peppermint tea and Fennel tea are beneficial.

                       v.         Decoction of Vrikshamla (Garcinia indica) or Palasha (Butea monosperma) or Tila (Sesamum indicum) and Kimshuka Kshara (Alkali of Butea monosperma)

·      Diet suggestions

                        i.         Include unctuous, hot, sour and salty food articles. Eat timely meals, preferably freshly prepared and warm.

                       ii.         Reduce caffeine and sugar.

                      iii.         Favor plums, apple, dark grapes, pomegranate, leavy vegetables, ginger.

·      Yogasana especially Ushtrasana (Camel pose), Bhadrasana (Butterfly pose), Gomukhasana (Cow face pose), Vajrasana (Thunderbolt pose) are beneficial.

Aartava Dushti and Menorrhagia

Causative factors

·      Upavasa: Excess fasting

·      Ati Vyavaya: Excess indulgence in sexual intercourse

·      Amla Lavana Katu Rasa Pradhana Ahara: Excess intake of sour, salty, spicy food, hot spices like garlic, asafetida, mustard, etc.

·      Ati Snigdha Guru Bhojana: Excess intake of unctuous and heavy food

·      Ati Vyayama: Excess physical exercise

·      Chinta: Grief, Stress or Tension

Pathogenesis

Because of indulgence in above said causative factors, Pitta Dosha, Vata Dosha and Rakta Dhatu (Blood tissue) are vitiated. According to Ayurveda, Menorrhagia is termed as Raktapradara. The aggravation of the Pitta Dosha is believed to be the cause of menorrhagia. In Raktapradara, aggravated Pitta envelops the Apana Vata (A type of Vata dosha) and vitiates it, thereafter these aggravated Doshas influences the Rajas (menstrual blood) thereby increasing the menstrual flow excessively both in amount and duration. Some women may experience abundant bleeding which can affect day to day activities. (Ref Sloka 4)

Symptoms

Raktapradara can be associated with PMS symptoms like abdominal pain, burning sensation, weakness in the body, nausea and rise in body temperature. There are also several possible causes of menorrhagia – hormonal imbalance, Pelvic inflammatory disease, uterine fibroids, Infection, tumors, or polyps in the pelvic cavity.

 

Ayurveda Approach to Menorrhagia

·      Cooling and astringent herbs and food articles are beneficial. (Ref Sloka 3)

·      Herbs such as Shatavari (Asparagus racemosus), Anantamool (Hemidesmus indicus), Ushira (Vetiveria zizanioides), Chandana (Santalum album), Draksha (Vitis vinifera), Lodhra (Symplocos racemose), Dhataki (Woodfordia fruticose), Nagakesar (Messua ferra), Ashoka (Saraca asoca), Amalaki (Emblica officinalis) are useful.

·      Ayurveda herbal preparations like Ushirasava, Chandanasava, Lodhrasava, Ashokarishta, Drakshadi Kashaya, Pushyanuga churna, Shatavari Ghrita, Shatavari Guda, Jatiphala churna are beneficial.

·      Some other useful Ayurveda recipes –

                      i.         Lajjalu is made into a paste and administered with rice washed water or juice of Durva (Cynodon dactylon).

                     ii.         Powders of Nagakesar (Messua ferra) and Ushira (Vetiveria zizanioides) is administered with fresh butter and cane sugar.

                   iii.         Boil 25 gm of Ashoka bark powder in 200 ml water and 50 ml milk and reduce it to 50 ml. Filter and drink when it is at room temperature.

·      Favor wheat, rice, ash gourd, snake gourd, raisins, pomegranate, dates, ghee and honey.

·      Reduce excess intake of pungent, sour, salty food, fish, spicy food, black gram, sesame seeds, horse gram, garlic, curd.

Aartava Dushti and Amenorrhea

Ayurvedic term for Amenorrhea is Anartava or Nashtartava. The absence of menstrual periods during reproductive age of a woman is Amenorrhea. In normal physiological conditions such as before menarche, during pregnancy and breastfeeding and in menopause, absence of menstrual period is very normal and does not cause any problem of the reproductive system. However, if there is absence of menses during other times of the women’s life cycle, it is a pathological condition which has to be treated.

Causative factors

·      Ati Shita Ruksha Bhojana: Excess intake of cold and dry food items. Ati karshya: Extreme weight loss or emaciation

·      Nutritional deficiencies

·      Eating disorders such as bulimic tendencies, Anorexia Nervosa, etc.

·      Ati Chinta: Excess stress or worry

Pathogenesis

In pathological amenorrhea, there is aggravation of Kapha Dosha causing Mandagni (Low digestive and metabolic fire) which then leads to deprivation of Pitta Dosha. Also, Kapha Dosha envelops the Vata Dosha and aggravates it. Then the vitiated Kapha and Vata Doshas obstruct the passage or orifices of channels carrying Artava (Artava Vaha Srotas), thus Artava (menses) is destroyed. 

Symptoms

Absence of menstruation is the main symptom. Also associated symptoms may include weight gain, bloating, fatigue.

Amenorrhea or non-appearance of menstrual cycle can also be caused due to obesity, hypothyroidism, hormonal imbalances, PCOS and severe anemia.

Ayurveda Approach to Amenorrhea

·      As there is vitiation of Kapha Dosha, Vamana or Therapeutic emesis is beneficial. And for Vata vitiation, Anuvasana Basti (Unctuous enema) is beneficial.

·      Anuvasana Basti (Unctuous enema) with Shatavari Ghrita or Baladi Yamaka Basti and Niruha Basti (Concoction enema) with Palash Niruha Basti and Dashamuladi Niruha Basti.

·      Oral intake of Phala Ghrita, Laghuphala Ghrita, Brihat Shatavari Ghrita, Kumaryasava, Ashwagandharishta, Dashmularishta, Draksharishta, Maharasnadi Kwath, Jirakadi modaka, etc.

·      Some other useful Ayurveda recipes –

                        i.         Intake of jaggery mixed with decoction of black sesame seeds daily morning.

                       ii.         Powdered leaves of Jyotishmati (Celastrus paniculatus), roots of Vacha (Acorus calamus), bark of Vijayasar (Pterocarpus marsupium) and alkali of Yavasa (Alhagi camelorum) with water is given orally every day.

                      iii.         Use of herbal preparations such as Shatapushpa Churna, Shatavari Churna, Yashtimadhu Churna, Pushyanuga Churna.

                      iv.         Japapushpa mixed with Kanji is beneficial.

                       v.         Use of Jyotishmati leaves fried in ghee mixed with juice of Durva.

                      vi.         Aloe vera juice with cane sugar is beneficial.

                    vii.         Milk medicated with Jivaniya ghan Dravyas are beneficial.

                   viii.         Decoction of black sesame, Selu and Karavi mixed with jaggery is useful.

                      ix.         Decoction of Manjishta and Lavanga.

·      Hot, dry and astringent herbs and food substances are beneficial (Ref Sloka 3).

·      Favor horse gram, fish, sesame seeds, black gram, buttermilk, curd, garlic, cloves, fenugreek, black pepper, cumin, ginger, fennel, coriander, mustard, asparagus, dill seeds.

·      Regular exercise and Yogasana mainly Padmasana (Lotus pose), Halasana (Plow pose), Dhanurasana (Bow pose), Sarvangasana (Shoulder stand pose), Shalabhasana (Locust pose), Bhujangasana (Cobra pose), Paschimottanasana (Seated forward bend), Padahastasana (Hand to foot pose) are beneficial.

Ayurvedic approach to Treatment of Aartava Dushti

Ayurvedic treatment of PMS is a whole-body approach that can eliminate or reduce the severity of PMS symptoms. Ayurveda is a natural treatment that can decrease or prevent Premenstrual Syndrome symptoms by addressing the root cause of PMS. Ayurveda focuses on an individual’s lack of mental peace and inner joy and helps her balance her body, mind, and spirit, thus improving overall health. The focus of Ayurveda treatment identifies and addresses the cause of PMS.

Correcting Agni

Low digestive fire causes imbalances in Dosha and accumulates Ama or endotoxins in the channels of circulation causing obstruction to menstrual flow and making it painful. Also, indigestion or endotoxins can cause symptoms such as nausea, vomiting, bloating, constipation, headache, diarrhea, etc. during menstrual cycle. Hence correcting the digestive and metabolic fire is necessary.

• Administration of herbal preparations such as Avipathikar churna, Trikatu, Haritaki and use of spices like ginger, cumin, fenugreek in diet helps to correct Agni.

Diet Suggestions

• Take light to digest meals, preferably freshly prepared and warm such as green gram, rice gruel, soups, etc.
• Include milk, green gram, snake gourd, sugarcane juice, coconut water, almonds, sesame seeds, pomegranate, rice, wheat, cumin, ginger, coriander in diet.
• Drinking lukewarm water helps to regulate menstrual flow by reducing cramps and pain.
• Reduce or avoid heavy to digest food items such as junk food, deep fried food, meat, cheese, etc, processed food, sugary food and caffeine.
• Reduce excess intake of spicy, sour and salty tastes such as chilies, tamarind, etc.
• Avoid fasting or long gap between meals, it is good to have regular meals.
• Eat slowly and mindfully.
• Include ghee in diet as it maintains digestion, nourishes the tissues, balances Vata thereby reducing symptoms such as cramps, bloating, etc. Also, ghee helps in stress, anxiety, mood swings, etc.

Lifestyle Modifications

• Avoid excess physical and mental overstrain as it increases Vata Dosha leading to aggravation of symptoms such as headache, anxiety, mood swings, abdominal cramps, etc.
• Avoid staying awake late at night or suppress natural urges as they aggravate Vata Dosha, especially Apana Vata which governs menstrual cycle.
• Get enough sleep. Try to get about 8 hours of sleep daily.
• It is important to have regular routine. Take timely meals, regular sleep routine, exercise routine. Take periodic breaks from routine hectic schedules, do everything at slow pace. Spend time in nature like walking, gardening, hiking, cycling, etc. Spend time with family and friends.
• Do regular exercise, Yoga and Meditation. Mild to moderate intensity exercise and muscle strengthening activities are beneficial.
• Stress reduction will help in balancing the hormones and improving blood flow to the uterus thereby regulating menses.

Ayurveda Panchakarma

Panchakarma therapies help in detoxification thereby cleansing the uterus and female reproductive system, thereby removing blockages and restoring balance of the three Doshas (Reference Sloka 5). Suitable Panchakarma is planned by the Ayurveda Practitioner according to the Dosha vitiation and health needs of the patient.

• Basti (Ayurvedic enema) especially Anuvasana Basti (Unctuous enema) and Uttara Basti (Intra-urethral enema) are beneficial. As Vata Dosha is vitiated in all gynecological problems especially in Dysmenorrhea, Basti is the best therapy to balance Vata Dosha. Basti has local and systemic effects. It causes downward movement of Vata, thereby normalizing Apana Vata. As the Ayurvedic oil enters into the channels of menstruation, it removes the spasm or obstruction in flow of menstrual blood caused due to vitiated Apana Vata because of the warm temperature of the oil and by virtue of oil’s penetrating and fast spreading nature.
• Virechana (Therapeutic purgation) is suggested when Pitta Dosha is imbalanced along with Vata Dosha. It corrects the digestive and metabolic fire, restored balance of Doshas thereby helping to reduce symptoms such as headache, burning sensation, acne, irritation. Also, in dysmenorrhea, it helps to relieve obstruction in the channels carrying menstruation thereby bringing relief in menstrual cramps.
• Shirodhara therapy helps in mood swings and anxiety. Lukewarm oil is poured on the forehead in a rhythmic manner following a head massage. Lukewarm oils balance Vata Dosha and pouring it in rhythmic manner helps in regulating brain waves, thereby helping in relaxation and stress relief. It also stimulates the pituitary gland.
• Abhyanga (Ayurveda massage) with lukewarm oil helps to balance all the Doshas, especially Vata. It improves circulation, removes blockage in channels of menstruation, helps ease different types of pain and discomfort, relieves stress and tension.

If diet and lifestyle are not followed during menstrual cycle, the Doshas are prone to get vitiated easily thereby leading to different menstrual problems such as scanty bleeding, excess flow, painful menstruation, irregular cycles, abdominal cramps, low back pain, anxiety, mood swings, constipation, bloating, nausea, headache, etc. As menstruation is a natural cleansing cycle which occurs every month in women, if it is regular and normal, then the body heals the imbalanced Doshas by itself, purifies the blood and lymph tissue and nourishes the reproductive tissue.  Thus, maintaining healthy menstrual cycle is important. Ayurveda has suggested diet and lifestyle to be followed during menstrual cycle.

Observations during menstrual cycle

Avoid physical overstrain, excessive exercise, lifting heavy weights, swimming, taking bath in public pools, sexual intercourse, massage, suppression of natural urges, day sleep, excess sleep, stress, adventurous sport activities as these interfere with the normal functioning of Vata Dosha which increases or decreases the menstruation. As the digestive and metabolic fire will be low during menstrual period because of aggravation of Vata Dosha, one should take light to digest food.

As every individual is considered unique, Ayurveda treatment differs from patient to patient. Ayurvedic treatment for PMS begins after thorough evaluation of Doshic imbalance by an Ayurvedic practitioner.